6 Week Check-Up and Update

Today I'm at 6 weeks 2 days post-op and while I've been away from the blog a while I'm still doing 3 session of physical therapy a week and gradually getting back to "normal". I think my physical therapist slowed down the rehab in comparison to last time to avoid the hiccup we hit last time that was either tendinitis or something else that kept me from progressing. 

Dr. Shapiro asked if I was running yet in my check-up Monday and when I said no he was surprised, but then again I feel as if I only just started walking without a limp and am gaining confidence on stairs -- so I was not in a hurry to run.  Of course, that day I went home and ran on my treadmill at home to prove I was capable!  Also, in physical therapy yesterday I started running (or, "rumping") in walk/run intervals, but it got more fluid as time went on and towards the end of 15 minutes I was cramping in my side, not my leg, that made me want to stop!
Some of the questions I asked of my doctor at 6 weeks, since I am always seeking more information:

Q: Can I kneel (while playing with my daughter, etc)?
A: You can't "damage" anything by kneeling, so if it doesn't hurt, you can kneel.
Note: YES! It HURTS to kneel, and this will go on for quite some time... But eventually it will subside to a manageable feeling!

Q: In my surgical report (which I had to request from medical records) it says "The core of bone from the tibial tunnel was then cut in half and placed withing the patellar defect".   Can you explain? Did you do this in my left knee 3 years ago?
A: Yes, it was done both times. An oscillating U-shaped saw is used to cut the patellar tendon graft from the kneecap, leaving a semi-circular void (defect).  An O-shaped saw is what is used to create the hole in the tibia where the graft is threaded (instead of a drill) so that a cylindrical bone plug is a byproduct of the preparation of the tunnel instead of the bone equivilant of sawdust. The cylindrical bone plug is cut in half so it's rounded on one side (to fit in the patellar defect) and flat on the top.  Once placed, it's then shaped down to match the kneecap surface. Before this method started being done, when the void was left there was sometimes cracking of the patella (stemming from the void) later down the road.
Note: I thought this was pretty awesome to learn! I tried to tell my husband twice, and I was excited to get in to enlighten my physical therapist who didn't know this was part of the procedure.

Q: Is the reconstructed ACL "stronger"?
A: I feel like doctors are hesitant to say "yes" to this one because there are lots of other factors to consider, but Dr. Shapiro said yes, the graft is stronger than an ACL because of how it's anchored, but without building the muscle back up around the knee and being mindful of the activities that cause the original ACL tear, it doesn't mean this couldn't happen again.

Q: What is the longevity of the graft?
A: As long as I'm alive, the graft is alive. It's a little different than the original ACL (clearly) and doesn't have exactly the same connection and responses to and from the brain, but for all general purposes, it's a living, breathing tendon and will keep on tickin' as long as I do.

Q: Will I tear the reconstructed ACL?
A: The good doctor then mentioned there was a girl who just entered the office while I was waiting who was there to be diagnosed for a potential 3rd ACL tear. He pointed out she was 14 and rail-thin for the first surgery, it happened again a few years later (same knee) but that she was a competitive cheerleader and by now she was much "thicker" than during her first two injuries. So the combination of her activity choice and her build let him to believe that in her instance, yes, it's likely it could happen again.  Although I play many different sports, none of them are particularly high-risk and even the cutting sports (like soccer) are played recreationally and just once or twice a week for an hour. That, combined with the fact that I'm relatively physically fit, committed to my rehab and (this one I'm guessing:) my activity level may decline as my kid gets older and we consider adding another one to the mix...  means it's unlikely that this should happen again. Not impossible, but, unlikely.

Q: I've done patellar tendon reconstruction on both knees. If this happens again, what do we use?  I have no more tendon to spare!
A: Cadaver patellar tendon. A cadaver ACL is not used because each body is different and there's no telling if the length of the ACL from a cadaver would be an appropriate fit for someone else's ACL reconstruction. The patellar tendon (cadaver or not) allows some flexibility when positioning and anchoring it into the holes created in the tibia and femur.
Note: Every doctor is different, but this was the recommendation of mine...

Q: Likelyhood of arthritis or pain in the knee in the future because of these surgeries?
A: More likely than someone without knee surgery. Not very likely for me in particular because I had no miniscus damage on my L knee and only about 5% on the right knee. Others who have more meniscus damage have more pain later on.  Also, future pain is much more likely in those who do NOT have their ACL repaired because then the knee can slip at any time without the stability of an ACL and cause meniscus damage, worsening over time with each slip.  Overall this puts me in a good position, even if there is potential down the road.

Q: Let's be honest. I'm 30... This is the second time this has happened...  Is it time to start suiting up with a brace on my knee(s) to prevent additional injury?
A: No.  A brace becomes a crutch and provides no benefit.  The braces you see professional football players wearing are generally to prevent MCL damage, not bracing their ACL.  Dr. S pointed out that professionals don't come back wearing braces. I thought I am far from professional, but I see his point. It is just a reminder to stick to the physical therapy to build supporting muscles back up, and maybe make some smarter decisions on the soccer field like focusing my efforts on things that don't require as aggressive side-to-side movement.
Note: Again, I feel this is something doctors may be divided on, but my physical therapist and doctor both agree there's no reason to start bracing.

And there you have it. I see the doctor again at 10 weeks. In the meantime, here's a fun image showing the screws from the post-op x-ray!



One week post-op x-rays showing titanium screws



ACL Surgery - Take 2! [Surgery Day Re-Cap]

It's been just over 6 weeks since my right knee ACL tear/MCL sprain playing outdoor soccer. In this time I was able to celebrate my 30th with some great friends and family, as well as attend a beautiful and super-fun wedding up north this past weekend (Congrats Schindlers!!).  Once the fun was over, it was time to get my game face on for surgery.

I tried to prep for surgery by doing the expected the day before- clean up, prepare the couch where I'll be sleeping the first few nights, do some grocery shopping to have snacks on hand... And luckily I also got to meet the brand-spankin'-new addition to the Schwartz family, Mr. Ashton Reid who was born on Friday the 13th! (I forget how small babies are in those first few days-- he is an absolute CUTIE!). It was a great distraction, and Congrats again to Jordan and Katy!

I had my reservations going into today's surgery.  This injury was a lot worse, with the sprain of the MCL and just general muscle tone already fading pre-op.  I also had pain when bending my right leg or putting weight on that leg while standing with it completely straight. I thought to myself that feeling "injured" pre-op (as opposed to feeling fabulous like I did prior to my other knee surgery) might mean that recovery would be more difficult. I can't say if this is true or not (seeing as how I'm not even a half day post-op as I type this) but Dr. Shapiro assured me that the two things were not necessarily linear, and that the pain I was feeling when standing was likely still from bone bruising.  This was good to learn, that apparently it can take 3-6 months for some bone bruising to completely heal, because I had started to convince myself that it was a mental thing. Going into post-op with a mental hurdle already in place would have made for a rough start, since learning to use your knee and surrounding muscles again is very much a mental challenge!

In the last few weeks I'd popped in to talk to Drew, the physical therapist I'll be seeing again. There were no Doctor's orders to do pre-op rehabilitation ("prehab" as I call it), so Drew gave me some at-home exercises with the goal being to fire my quad muscles. In the same visits he mentioned he's "got a plan" for me this time around, to hopefully avoid the oh-so-frustrating hiccup I had last time around 22 days post-op.

When this morning rolled around, the nerves really started to hit me. Which, in my defense, I think my way of being anxious or nervous is relatively laid-back... But still I felt my heart rate rise at times, or had a mental flicker reminding me that I'd soon have drilling done to my bones! :/  Luckily I was sent a ridiculous amount of texts and facebook messages of support from friends and family who knew I was going under the knife today, wishing me luck and a speedy recovery. Have I mentioned how absolutely lucky I am to be surrounded by such great people?! My nervousness must not have showed much, since the nurse anesthetist asked if my husband and I "were in the medical field" since we seemed so calm about the whole thing just minutes before surgery!

The schedule was very much like last time, just 2 hours earlier.  Today we had a 10:30a arrival, 12:30p scheduled surgery (which started closer to 1pm, I think), 3p-ish awakening from anesthesia, and by about 5p we'd already gotten home, got our daughter from a friend and were chillin' on the couch with the thermocompression unit (similar to THIS, but with a sleeve for the leg) wrapped around my knee!

Post-op at the hospital, Dr. Shapiro informed my hubby that they had to remove about 5% of my meniscus. This isn't much to speak of, but according to MRI they were not expecting meniscus damage.  Otherwise it sounds like surgery went as planned.

At home I focused on getting some water in my system, a little food, and using the thermocompression unit to keep me comfortable. For fun I decided to try to flex my quad of my surgical leg, expecting it wouldn't be possible since it normally "shuts off" due to the trauma of knee surgery. To my delight, it DID flex without having to focus too strongly on it, and it doesn't cause any additional pain to do so.  Granted I am not flexing with all my might, but firing at all is the goal, and I was excited to see I could do this (and, continue to do it) as a nice prep for upcoming physical therapy!

I also remember last time I had this surgery that standing up and taking my leg out of an elevated position was very VERY painful as the blood rushed to the knee. Today I've been up and around just a few times since I've been home from surgery, and either the pain meds are better this time around or I'm just having a more positive experience! I am hoping for the latter, and this is giving me a glimmer of hope that post-op will indeed be easier the second time around.

This does not mean that I expect to "get away" with taking it easier in physical therapy (PT). I still fully expect to have to feel the burn as I get back range of motion (ROM) and fire the muscles. I am grateful that I know what I'm in for (even if I'm not looking forward to it) and am ready to commit to the physical therapy to ensure a full recovery!

Let's just hope this positive attitude and committed demeanor don't get too shaken as the reality of it all comes upon me! Meanwhile I'm looking forward to my visitors/helpers and spending a little extra time with my 11-month old daughter, Ellie... Even if it does mean we'll be learning to walk at the same time!!

I'm Baaaaaaaaaaaaack! And Not in a Good Way... [36 days pre-op]

When I went down with this injury, I knew it was bad. I expected the worst, hoped for the best and... Well... Ended up somewhere in between.

In my much-anticipated reunion with Dr. Shapiro I told him I was afraid for the "jiggle test" he'd do on my newly injured knee... I remember from last time that it was none-to-pleasant and the Doc promised he'd "be gentle" this time, though I assumed you can't exactly be gentle when you have to check for torn ligaments inside the knee.

To my surprise, he was more gentle. But unfortunately, this gentleness was a result of my knee being so loose that it didn't require much effort for him to know that both my ACL and MCL were torn. In hindsight, I wish the jiggle would have hurt just to prove the tendons were intact!!

The expected occurred... The tears came and I stammered about how I had a 9.5 mo old baby girl at home that I need to chase around and there wasn't a good time to be laid up due to surgery. Dr. Shapiro kindly handed me the generic box of tissues as I collected myself and tried to reassure me that I've been through this before and did very well -- so I can do it again. He encouraged me to schedule the surgery sooner-than-later because there was nothing to gain in putting it off.

Due to the MCL injury, surgery could not be scheduled for at least 4 weeks to give it time to heal (because apparently it's not a completely torn MCL, but a stretched or partially torn tendon that will, over the next 4 weeks, regain it's tightness/elasticity). We put July 17 on the books and in the meantime, scheduled my MRI for the next day to determine if there was additional damage.

Still, I was outfitted with a fancy leg brace that goes mid-shin to mid-thigh that will support my leg (keep it from the lateral slip that caused this in the first place) so that the MCL heals correctly and I don't do any further damage between now and surgery. I've never been one for accessories but am getting used to the brace now, after only 4 days of wearing it.

This morning I went over the MRI results with Dr. Shapiro and luckily we learned that there is no damage to the meniscus (which, actually is rare to not have damage, so this is good news) and aside from some bone bruising, the injury is exactly what Dr. Shapiro had expected.

Between now and surgery I will do some exercises at home to strengthen the muscles around the knee and maintain maximum range of motion (ROM) as the swelling subsides from the initial injury. I spoke with my good man, Drew (who was my best friend/worst enemy as my physical therapist last time) and told him to expect me back in mid-July.  After the initial, "What did you DO?!"  and exchange of pleasantries, I realized I'm still uneasy with my leg in his hands and that's going to be one disadvantage to the therapy after surgery this time -- I know what to expect, and I know at times it's going to hurt like hell.  Luckily I documented my previous recovery with this blog so I can follow along and try to keep pace with myself!

I also know in the end it will be worth it, because I have a baby girl I plan on chasing around for many years to come, and hopefully I won't have to hang up my own cleats / turf shoes / tennies just yet...!

Where Did the Time Go?! [1 yr post-op]

As 4/14/10 snuck up on me, I found myself plenty occupied with the current going-ons in my life, like my recent purchase of a new home and my 1-month away nuptials. It's funny how no matter what is going on in your life at any given time, it seems to consume you, as if that's the way it's always been!

I remember just 1 year ago when I had been consumed by preparing for surgery by cleaning the house, changing to a removable shower-head, having books and snacks handy right next to the couch where I knew I'd be spending numerous hours... Even so far as to drive by the hospital (which is about 1 mile from where I live) and do a 'dry run' to find out what entrance to go in, where my mom and Eric would park the car... I wanted to be an educated patient in every way!

No matter the googling, blog reading or 'dry runs', nothing quite prepares you for a surgery you've never had. Being that this was also the ONLY surgery / medical issue I've had beyond a sprained ankle, it was definitely a journey for me and I'm glad to have the blog (though my re-reads are sparse) to have tracked my ups and downs along the way.

And, the real reason of the post- A 1-year post-op update! I am happy to say that life is "back to normal" when it comes to activities. Indoor soccer is finishing up in the next few weeks and this was my major hurdle seeing as how there is so much contact, cutting, turning and leg-tangling in indoor soccer compared to outdoor. I used to get VERY nervous before the games and caught myself being 'careful' which to the untrained (and trained!) eye actually equated to 'awkward'! But I have gotten more confident and even in our game last night there was some cutting and a few knee-banging, leg-tangling plays that definitely make me think twice about how it could potentially put me back in Dr. Shapiro's hands. Luckily, beyond some bruising or soreness, indoor soccer hasn't given my knee any trouble.

And my other activities- ultimate frisbee last fall, snowboarding this winter, hitting the driving range, outdoor soccer starting up last weekend, softball pre-season practice... have all proven OK to play! I'm yet to get back onto a volleyball court, but that's more a combination of busy schedule and lack of opportunity than it is any fear/ protectiveness of my knee!

In day-to-day,

• I still get a popping noise sometimes when going from extended to bent leg.
• My surgical quad is still smaller than my non-surgical.
• I've noticed very faint 'grinding' noises in my knee as I go from a fully squatted position to standing--but I also hear something similar in my non-surgical knee, so I wonder if that is just use and age!!
• I'm no longer doing any re-hab or PT aimed at my knee- only participating in aforementioned sports! Now that weather is getting nicer I hope to get out and run and perhaps start thinking about a half marathon!
• Incision looks good. Still a white scarred line from the incision, but it blends pretty well into surrounding skin and moves freely on top of my knee
• I have spotty numbness to the outside of my incision area, but a relatively small area.

So, all is well here! I stopped into my re-hab spot yesterday, as it's close to my work, and just being there reminded me of the fears, tears and milestones that accompanied knee surgery... and as nice as it was to see some of the trainers and boast of how well the knee is holding up -- I hope I never have to return unless it's again by my own choice to visit!

I'm Baaaaack!! [Shy of 6 Months Post-Op]

Funny how things work. I am 2 days shy of my 6-month ACL surgery anniversary and this weekend a few opportunities presented themselves which allowed me to prove to myself that I'm ready for my comeback!

We got a group together for the 3rd round of pick-up Ultimate Frisbee on Saturday, which as usual was a lot of sprinting, stopping, changing directions and a bit of jumping. Being that we play outdoors and in cleats, this has been a major confidence booster for me when considering my return to soccer.

Our normal co-ed team won't be starting indoor soccer for another week and a half or so, but the outdoor season is still wrapping up. I've heard the fields are in pretty rough shape, and fellow ACL rehabber, Jeff, opted out of the outdoor seasons entirely this summer partially because of the pounding and poor field conditions. So when I got a text from our captain on Saturday asking if I'd be able to sub on Sunday (yesterday) for outdoor, I was a combination of excited and nervous! I said yes, but worried because I'd hardly touched a soccer ball since surgery, and because I didn't want to hurt myself if the fields were that bad.

Luckily, the ground was kind of soft thanks to the previous week worth of rain, and aside from some expected ruts in the field, the game seemed to be pretty forgiving to my knee. [Note: I have not and don't plan on using a knee brace.] Once I got out there, I felt pretty strong and even tallied an assist with a corner kick! Otherwise it wasn't a brilliant game for me by any means, but it was on par with where I was pre-surgery, and that's all I can ask for!! I must also say that it was fun to be welcomed back to the field by my teammates-- I've missed being out there with you all!

I was delighted that things had gone so well in soccer, only to come home to a message asking if Eric and I would mind subbing for 2 games of softball that afternoon. How could I say no, seeing as how I'd conquered UF and soccer already this weekend?! Softball's never been a strong sport of mine, but it was fun to get back out there, toss the ball around and take a few swings. It feels good to be back!!

One day later, I am pretty sore, but I'm sure part of that has been some laziness in my exercise routine prior to this active weekend. I think there was a little unintentional overcompensation at times, because my non-surgical leg (quad, calf and even shin!) is more sore than my surgical leg... but for the sudden spike in activity in 2 short days, I don't think I would have expected any less.

Tonight, it's off to yoga, which I hope will end up with some much-needed stretching. But I couldn't be happier with the weekend's turn of events and opportunities to get back in action. My nerves are (mostly) settled and now I can look forward to my next activity to conquer: Indoor Soccer!

Until then, a big CONGRATS to Missy and Nic for their wedding this weekend-- I can't wait to walk (not limp!) down the aisle and be a part of your big day! And in addition to all this fun stuff to celebrate, I now have my own engagement to add to the list, as of 9/26/09! Perhaps it's time for me to start a new blog! ;)

Ciao, Dr. S! [20 Weeks Post-Op]

From the title, I'm sure you can guess... My good man, Dr. Jeffrey Shapiro gave me the final farewell yesterday in my follow-up visit! He admitted that I came out of the gate a little slower than most, but that I've made up ground since then and am right on track. I had often looked forward to my visits with Dr. S to get such confirmation, but at the same time I'm grateful that I had a (mostly) smooth road to recovery and that I'm nearly back to normal!! This must be what Drew felt like when I ended things with him, and PT... *sigh*

Despite halting doctor and PT appointments, I'm not done yet! PT (at home) will be ongoing, as I hope to stick with doing things on my own at least 3 times a week until I can work my way back into sports. For instance, today I strapped on my soccer/UF cleats for the first time and got a taste of the field. Unfortunately tomorrow's soccer practice was cancelled, but I will be doing a workout and eventually heading up to the driving range to dust off the 'ol golf clubs too! Knowing the doctor doesn't need to see me again gives me that 16-yr-old-with-a-set-of-car-keys feeling of freedom again!

But I must share... Yesterday's 'closure' with Dr. S did end on a bit of a personal sour note. My good friend Wendy was in one of his OTHER exam rooms, getting the news that she'd torn her ACL (just like me- playing flag football!). So, as much as I would have liked to avoid my injury, I am almost glad I have the experience (and blog!) under my belt to help reassure her that she'll come through it just fine!! [You can do it, Wendy!]

The gorgeous bouquet I received from Miss Wendy... just for helping! Aww, shucks!

Things I'm looking forward to: Golfing this weekend, Yoga class starting in 2 weeks, and hopefully dusting off the frisbee one of these weekends for some good 'ol fashioned pick-up games!

'Little Things' Make a Comeback [19.5 Wks Post-Op]

Somewhere along the way in my recovery I think I stopped celebrating the 'little things'. I kept a fresh perspective of what I could and couldn't do when it came to exercising or getting back range-of-motion, but the more I think about it, that's not what I'm excited to be doing again... And as gradually as they've come, there are lots of little things I'm happy to say I do without wondering "what will this do to my knee?"...

For instance, today I woke up, got out of bed and walked across the room. Ta-da! There once was a time when that was my biggest challenge! But now I'm back to my groggy "I don't wanna get up" mindset, instead of thinking step-ouch-step-ouch as I used to hobble away from my resting place. Then it's showering. And getting back upstairs to get dressed. And putting on high heels! And yes, even taking out the trash-- because before I was helpless, and while it's not a desirable task, I can.

Next, it's pivoting on my left (surgical) leg as I get into my car (which is quite low to the ground). No more backing up near my seat, having weight on both feet and gingerly lowering myself into the seat. Plant, pivot, sit and DRIVE-- one (mostly) fluid motion! At work it's lots of sitting, but there is still getting in and out of my chair, crossing my legs, or scooting around in my cube on my wheelie chair and not feeling any pain. Ah, the little things!

Today at work I had to cut a strip away from a very large piece of paper from the plotter. Given the size, I figured the floor was my best work space. So this meant squatting down (and getting back up!) and also some kneeling (*gasp*)! I am still cautious when kneeling and putting weight where they took my graft from, but it turned out to be a surprisingly normal feeling!

Regarding my PT-at-home: jumping is getting easier but still challenging. I can run on pavement w/o additional soreness. I even completed a yoga DVD (complete with child's pose!) on an 'off' day, and there were lots of movements I am proud to be able to do again, no matter how simple.

Monday (8/31) is another follow-up with Dr. Shapiro, and Wednesday (9/2) has a high potential of being my first soccer practice! [Despite being given the OK to 'practice' last time I saw Dr. S-- I've still been sticking to PT routines. I may be eager to get back out there, but I want to feel confident first...]

Have a wonderful weekend!

How I Broke Up With PT [4 Months Post-Op]

Tomorrow I will be 4 months post-op. If you're an avid reader (or, recap HERE) you'll know my Doctor gave me the impression I only had a 4 month recovery (or, perhaps he meant 4 months of PT?…). I was skeptical then, and now that I'm here, I still know I'm not at 100%, but I'm doing what I can to get there.

Over the weekend I got yet another medical bill, and while I am blessed to be insured, I'm also blessed with a mathematical mind. Is what I'm paying for in PT really worth it anymore? Before I used to tell myself that having someone guide me, albeit 1x per week, was worth any cost to know I'm on track. However, the last month or so was very hands-off for Drew, and even regarding equipment use- aside from the 1-leg press and a BOSU ball here and there, most everything I can do at home. So, I approached Drew yesterday as I came into PT, asking "Is it OK if this is my last visit?" Drew gave me a long look and asked, "Are you breaking up with me?!"

We did some L-to-R comparison of lunging, jumping, balancing on each leg individually, as well as measured circumference at my knee, lower and mid thigh. Here's how I see my progress as of today:
Strength ~ 90%: For instance, I can 1-leg press pre-surgical weight, but it's still a little shaky. Which brings us to...
Control ~55%: It is still difficult to absorb the impact when jumping and landing on my surgical leg. Controlling the motion of something like a 1-leg squat is very difficult and borderline painful to do as I work into deeper bending. I think toning the muscle around my knee as I get it back will help improve this.
Mass ~85%: I still have mass to regain in my L quad, but even the mass I do have is not as solid as my R leg. I know this will come in time, but as trainers have told me along the way, I have further to go than most people based on the large size of my non-surgical quad!
Endurance ~95%: I might be guessing high, but if my knee were miraculously healed tomorrow, I think my endurance would be pretty good. Although I might take that down to 90% or so when I think of playing the full duration of a soccer game with minimal subs, or the continuous sprints of ultimate frisbee.

Now that I'm PT-free I can consider my options (what unattached girl wouldn't?!). Buy some equipment for home exercise, like a BOSU ball? Or spring for a gym membership to have equipment at my disposal? Or go to some open swims at a local pool for some 'low impact' jumping to work on control? I know I can always call Drew for questions, pointers, or help… plus he provided me with a few pages of exercises to keep working on. Any way I work it, I'm pretty confident I can do this on my own now.

Sorry, PT… It's not you, it's me. ;)

We Talkin' 'Bout Practice! [15.5 Weeks Post-Op]

Monday (7/27) I met with my surgeon, and despite the fact that I didn't see him until over an hour after my original appointment time, it was a good, quick visit. My physical therapist didn't give me any ammunition to go in with, since I seem to be on track (I just have to get back that muscle mass and control!!). Also, I haven't had any odd pains or limitations to speak of, so I feel like we're doing things right so far.

One question I had was about distance running. I've kept to 1.5 miles or less up until this appointment, because I don't want to develop bad habits since my surgical leg still has muscle to get back. [Yes, I do still favor my leg a bit when running.] I figure if I keep the distance low, I can pick up the speed, and when I run more quickly, it seems to lessen any limping. Dr. Shapiro said up to 2 miles would be fine, so I will stay under that until I see him again in a month. I hadn't planned on running the Detroit Marathon in October anyhow... ;)

While it's nice to get back into running, that's not all I've been eager to do! Since I'm up for most any sport (except basketball, which I've never been too great at) I had to ask, what ELSE can I do? Dr. S threw a blanket statement out there, "You can run some drills and practice pretty much all of your sports now, just don't participate in any competitive games." I eyed him skeptically because really, isn't it the motions, not the contact I need to be worried about? But I also wasn't going to look a gift horse in the mouth either. So, to be sure he meant 'all' I thought of one of the sports that would be rough on the knees and said, "Even sand volleyball?" His response: "Well, no. That'll be next year. Too uneven." Luckily that's the answer I expected, so I went for a more hopeful one... "Soccer?" "Yes." Woo hoo! Look out local high school turf field!

In hindsight I should have asked about more activities, but by the time I would have gotten through the list of sports I want to start playing again, I might have kept him there another 10 minutes. ;) For now, it's all about doing what I am comfortable with, and stopping if there's pain.

Fine Tuning My Knee [3 Month 1 Week Post-Op]

"How's your knee?" ... It's a loaded question that I get all the time. I think most people are just being nice, but if you care to read, here are some extra specifics.

Being over 3 months out, I figure I'm more than halfway to recovery. At my last follow-up appointment with the surgeon, he said we're looking at a 4 month recovery, which normally I'd be super excited about. However, seeing as how I'm not a professional athlete (surprise!) I believe I'll be taking the full 6 months before I decide to commit to a sports team, perhaps subbing once in a while before that. We'll see-- I want to be steady and confident before I go out on a field and act timid and end up doing something dumb because of my fear.

Current Abilities:

• Walking without a limp (including speed-walking)
• Running (slight limp when I'm slower, but the faster I go, the less I limp). I have not tried a dead sprint yet, but really, what's the rush?
• Going up stairs- Very even and seems controlled. Even taking stairs 2 at a time doesn't seem to show much weakness.
• Going down stairs- I can still feel the unsteadiness in my surgical leg as I move my non-surgical leg to the next step down. While some days it seems easier than others, there isn't a time I've gone down stairs and 'forgot' about my knee.
• Jumping- When jumping on both legs (think: jumping rope) I can feel my right leg doing more work the longer I jump. When jumping on just my surgical leg, it's still not developed enough to accept the impact of the jump like my other leg does.
• Bending/Straightening- I can bend my knee so my heel touches my butt, though I'm still not confident when squatting all the way down and using my body weight to bend it. For straightening, there is some uncomfortable feeling when it gets close to hyperextending, but I think I need to keep working to make sure I don't lose range of motion there. My kneecap also seems to 'catch' or 'pop' every so often when I go from straight to bent, but it's not painful.

Current Focus/Exercises:

• Doing PT at home: I've been a lot better with this since my birthday, keeping a promise to myself to do my part in my recovery. I take 1-2 days off per week, but otherwise try to run every other day, and on the in-between days I'm doing more pointed exercises like lunges, step jumping, shuffling... etc.
• Physical Therapy with Drew: I am happy to announce I'm back up to my pre-surgical 1-leg press weight, as of a week ago! It feels good to be 'back to normal' in that sense, even though it doesn't translate to a 'back to normal' leg as a whole. PT will continue 1/week at least through the end of this month.
• Quad Strengthening: Lunge, lunge, lunge!!
• Calf/Knee/Jumping: Lots of jumping and quick shuffling to build up not just my muscle, but also the motor skills to be using the muscles AND moving at the same time. One exercise I do- Stand on L leg at a step with R leg resting up on step; In one jump, land with R leg beneath you, and at the same time lift L leg to touch up on step; Alternate which leg you land on (and which touches the step) after each jump, and do this as fast as you can for 30 seconds. I find this is a great gauge of how 'steady' my surgical knee is underneath me, as well as controlling that leg as I quickly touch the step through the repetitive motion.
• Jumping on one leg: Being able to balance just isn't enough. Trying to jump and accept the impact (as I mentioned before) is a whole new game. In PT on my own I try to jump forward in a straight line on just my surgical leg, and land softly. I still have a ways to go here.

Drew told me that the exercises I still feel 'unsteady' doing are the ones that are the last to come back, so I'm well on my way to recovery. Also, I have another follow-up appointment with Dr. Jeff Shapiro next Monday afternoon, and I expect more good news there!

Jumping for Joy (Literally!) [~10 Wks Post-Op/ 3rd Follow-up]

This afternoon I spent about 1 hour waiting (and, oh yeah, got another set of identical x-rays taken...) for my 'ol pal, Dr. Jeff Shapiro. As I waited, I tried to think of intelligent questions I should be asking at 2+ months out, but since there's no squeaky wheel, nothing really came to mind. So, when he finally made his grand entrance and we exchanged our how-do-you-do's, he surprised me with this:

Dr. S: "Two down, two to go!"
Summer: [Obviously confused] "What?"
Dr. S: "Well, you're at two months, and only two more to go!"
Summer: [Still obviously confused] "Oh, um, for recovery? Or..?"
Dr. S: "Yeah!"
Summer: [Yep, still confused] "I thought it was more like 6 months... No?"
Dr. S: "Nope!"

Playing back this conversation now still makes me chuckle, because even though he clearly stated it was a 4 month recovery (total), I still don't really believe it. I mean, PT has been going well and all, and aside from some muscle I need to get back in my surgical quad, I'm feeling pretty confident so far. However, when I've had it in my head that all my fave activities are off-limits for 6 months, it's hard to change that placeholder in my head from mid-October to mid-August. Plus, a big fear of mine is coming back too early and not being back to 100%. But if I can't trust my doctor's word, who do I listen to??

The rest of the 5 minutes (if that!) with Dr. S was uneventful- Range of motion is "great", swelling is minimal, and I have no complaints of pain... "See you in a month!"

So- I am resisting the urge to be completely ecstatic and drunk with happiness about this 2 month shave off my 'return'. Why? Well... while I feel I'm a positive person, I want to remain realistic and, perhaps, a little on the 'safe' side. We'll see how things work out, but I guess I'll limit myself to just a sip of this delight cocktail for now!

In the event I'd like to celebrate by jumping up and down - well, now I have been advised by my physical therapist to go on ahead and do it! Today in PT, among other things (see my ACL calendar), I started jumping. It's really a strange experience to try a simple motion like that, which I've avoided for the last two months, but is so elementary. Like everything else, I started with a little hesitation, but once I realized my knee wasn't giving out on me and there wasn't even a pang of pain, I became a 3x30 rep jumping bean! PT also brought on more Bosu Ball fun too...!

So, between the good news from the Doc and trying new things in PT, today was a great day! Not to mention, by next week I'll only be at PT once a week (currently at 2/week)! Booyah!

My First 1-Mile Run [2 Months Post-Op]

Since my last PT visit, I hadn't made much time to get in quality exercise for my knee over the weekend. I blame being preoccupied, but a little of it was laziness. Over the weekend there was a lot of walking and standing, and the 'ol knee held up well. Occasionally an ache would find it's way around my knee, but nothing too painful. Either way, I was looking forward to today, since my last PT visit was finally a break from the monotonous routine I'd been doing.

Today's surprise was the 'timed 1-mile run'. As an ex-cross country runner and being an athlete in general, I know I used to be able to easily run 1 mile. Plus, I've done previous sessions of run-walk intervals in PT, covering more than 1 mile, but today's challenge was to do 1 mile running, and at a decent pace. So, once I'd done an 8 minute warm up on the elliptical and stretched a little, I headed for the treadmill. Drew was not over my shoulder during the run, so I didn't burn myself out on it, but I did make sure to turn up the pace from previous PT runs (from 6.0 to 6.5). I finished in ~9:30, and for my first mile back after knee surgery, I am OK with that! (Plus, I know I could have gone faster if I had to, but I still had a full slate of PT ahead of me!).

The run left me whipped, but as usual, I felt really good about it once I was done! I did a handful of other exercises (including shuffling side-to-side between cones; also pushing off side-to-side in a speed skater fashion on a slip board) which had me working on sideways movements and adding in a little squat motion as well. It's good to know I'm getting to a point where it's not all about the range of motion in a straight line!

While I did have to go down in weight on the one-leg press today by ~10#, I was fine with exhausting my leg muscles to the point where they were shaking throughout that exercise, and others. Lunging is still difficult to put the weight evenly through my surgical leg, but practice makes perfect, right?

Next Monday (just shy of 10 weeks post-op) I'll see the Doctor again and make sure I'm on track!

I haven't posted pics in a while, but then again not much is changing. Swelling seems minimal, the incision is healing up nicely, and the definition in my legs is coming back, little by little. The only thing I might ask about is the dark spot that still remains on the back of my knee where I had dark bruising after surgery. I am sure it's normal, but just out of curiosity.

"Rumping" [6 weeks, 4 days Post-Op]

When I left you, dear reader, I had told you of my first attempt at running. I have since undergone yet another PT session (which included about 10 minutes of 2-minute intervals of speed-walking and then 'running') ... but I wouldn't call it running. It's more of a cross between limping and running... which my good friend Jesse so cleverly coined "Rumping".

Today I gave the run/walk intervals another try. I was advised by Drew to go to a track (meaning level surfaces and a nice padded course) but since there was a soccer game going on in Berkley's track infield, I refused to run around the game and provide entertainment for the ~100 people there. So, I went outside of my trainer's wishes, and hit the streets (very carefully, might I add). First, it was taking my walk from a slow, to normal, to eventually quick pace. Then, once I felt comfy, I tried running again. It felt just as awkward as the first two times, but if nothing else, it felt good to be out, trying, and breaking a sweat!

I believe the reason I can't shake the limp while running is I am (1) still having a hard time mentally trusting my surgical leg, (2) my muscle mass in my surgical quad is substantially less than my non-surgical and (3) when I do run, I am not letting my surgical leg extend out all the way, therefore I'm running shorter strides on that leg versus my 'good' leg. This overcompensation caused a little pain in my 'good' leg's hip towards the end of the run, but nothing I feel when walking or going about my day-to-day.

Otherwise I feel I am reaching a point where I actually sometimes FORGET about my 'bum' knee! It is a wonderful thing. The more I find myself putting it out-of-mind, the more I realize I am getting back to that 'normal' lifestyle I so desire. In the coming week I'll still be seeing my trainer 3x, but after that we've decided I'm ready to go to 2x / week. This can only mean one thing... PROGRESS!! :)

2nd Post-Op Meeting w the Doc [Nearly 5 Weeks Post-Op]

Today was a gorgeous day to be able to walk (slowly, and controlled...) out of work at lunchtime and eventually make my way to the Doctor's office for my 5-week follow-up appointment. I went in thinking that I would tell Dr. Shapiro of my set-backs in recovery, or maybe even have Drew make a visit (since the PT area is just downstairs from the Dr's office) to fill him in on my progress thus far and really have a big chat about it. As we know, things don't always go as planned.

Firstly, I had another set of x-rays taken. I mentioned that I already had x-rays taken at 1 week post-op, but the assistant said she was just following doctor's orders, so we both went along with it. Since the x-rays were identical to the last set, I felt they were a waste. Perhaps there is a small percentage of patients whose titanium screws (which hold the graft in place) may shift? Perhaps I'll google that... ;)

When Dr. Shapiro entered the room, we exchanged pleasantries, and I dove right into the discussion Drew and I had about my potential tendonitis, and how we felt it was setting back my recovery. When I told him that the tendonitis was in the area of the patellar tendon (where my graft was taken from), he seemed to pause a second and cock his head in misunderstanding.

"Well, you know, pain in that area is not necessarily tendonitis. I mean, that is where we took your graft from, so of course there is going to be some pain in that area.." he said. Well, this was followed up with how every recovery is different, and launched a discussion of pain management. I told him I've been off Vicodin for some time now, and only popped some Motrin (~600mg) every now and then for a two-birds-with-one-stone throw at both pain and inflammation. Can I really tell the difference when I take it vs not? Not really. But people also told me that Vicodin would be a god-send, and while I'm sure it helped dull some pain, it wasn't all I thought it'd be either. In the end he wrote me a prescription for something comparable to Motrin and told me to take that, mostly for inflammation that could be causing my pain. I am not a fan of popping pills, but Doctor's orders!

So, after our brief discussion of my maybe-tendonitis-but-not-necessarily, Dr. S had me sit with my legs extended out in front of me on the exam table. With my leg relaxed, he carefully manipulated the knee cap and poked around a little at the swelling, which seems to be in control. Next he had a look at my extension, which we haven't measured lately in PT, but is definitely at zero, if not -1 or so. Then, he had me slide my heel towards my butt and bend the knee as much as I could. Range of motion was "great" (though I still have some work to do on that bend!)... But for now- I'm on track!

After this, I extended my leg back out, and he grabbed my lower thigh with one hand and upper shin with his other hand, and did a little jiggle-jiggle to test the stability of my ACL (I assume, anyway) and those few things wrapped up the physical exam.

Once done, Dr. Shapiro was pleased with where I was and said I was right on track. God, that was good to hear after beating myself up over the last 2 weeks about my inability to walk w/o a limp or being 'behind schedule'. I was so happy that he didn't push the thought of tendonitis on me or give me any indication of being off track in general. I have too competitive of a spirit (even with myself) to have to deal with negativity that would have come from such focus.

I had them print me today's set of x-rays (which, truly, ARE exactly like the 1-week, so I won't bother uploading) and headed for PT. Drew was glad to hear the doctor was happy, and between the three of us, I think we will all be delighted as I can focus on the coming weeks and getting back to 'normal' !!

Note: I just heard meow-ing on my porch (we do not have a cat!) and it's a black cat! I hope that's not a bad sign... !!

Could the Limp Be Gone?!? [4.5 Weeks Post-Op]

I've had my set-backs in recovery, and in my last blog at 4 weeks post-op I talked about my continued pain when attempting to walk, and how it's likely due to a case of tendonitis. This pain was forcing me to limp, even when I really focused on evening out my stride.

While I'm still at PT 3 times per week, we've been taking it easy for about a week and a half, doing ultrasound in the area of my patellar tendon and locally icing directly on the skin. I knew patience (and a positive attitude!) would be a must as I overcame this hurdle.

I must say I'm having a bit of writer's block to describe just how I've come to ask myself... Could the limp really be gone? It comes down to this- up through this morning (I think!), I still couldn't seem to stop favoring my surgical leg. However, this afternoon I was on the phone and decided to take a short walk down the street and back. I was walking with control, but the pain was minimal if anything, and I realized I could walk normally!

Perhaps it helps that I was just doing PT at home and stretching. Or maybe it's that I was distracted with conversation. But this little triumph had me excited, so I had to share!

Meanwhile tomorrow is my 5 week follow-up with Dr. Shapiro. I'm looking forward to getting his opinion on my progress, and moving on from here!!

Screws and Glowing Reviews [8 Days Post-Op; First Follow-up Visit]

With a promise from Drew that he'd be kinder to me in PT today than Monday, I breathed a little easier as I limped into the building wearing only the immobilizer. We started out on a stationary bike, again using my right leg to control the rotation of the pedals, and slowly working my way to full revolutions (causing my leg to bend to an uncomfortable but somewhat tolerable angle).

With the exception of a little forced straightening (which, I am pretty much there on my own, so it's not nearly as painful as bending), we stuck to some classic exercises to work on my range of motion. These exercises can be found in the 4/22 entry on my ACL Calendar.

Immediately following PT, I went upstairs in the same building to have my 1 week follow-up visit with Dr. Jeffrey Shapiro.

First, x-rays were taken. I am not sure this was entirely necessary, since there were no bone issues found in the pre-op MRI nor seen in surgery. However, this time I was all for it, because I wanted to see the two titanium screws that were holding my reconstructed ACL (aka, patellar tendon) in place! How do you like 'em?


After x-rays were taken, I had to wait a while so I listened to the hub-bub of the doctor's office that was going on outside of my exam room. I was so glad to be on the other side of the surgery now, and while there is still a lot to experience and learn, at least this wasn't all brand new to me anymore, and I wasn't nearly as scared!

When Dr. Shapiro finally came in, he gave me eye contact, a firm handshake, a smile and the inevitable question, "How are you doing?" I was comforted that I didn't feel like 'just another patient' and I give Dr. S credit for that, which perhaps I didn't give him the first time I met him.

The physical exam was short. First, he had me straighten the leg on the table in front of me (and said, "Good!" when he saw I could straighten it to zero degrees). Once straight, he placed his hands at the top and bottom of my kneecap which caused a jerk reaction: my body went completely stiff and I grabbed his closest arm (thanks a LOT PT!!). We actually both had a laugh at that, as I apologized, relaxed and he said he was just glad I didn't hit him! hehe...

With his hands at the top and bottom of my knee, he carefully manipulated the kneecap, squeezed a little here and there, and finally, tested for looseness. For you dedicated readers, you might remember how painful my initial visit with Dr. S was when he did this same test for 'looseness' and originally diagnosed my torn ACL. I am happy to report that he was not only a little more gentle this time, but thanks to a successful surgery, there was hardly any pain.

Finally, he had me bend it to 90 degrees (which, since I had recently iced after finishing PT was a little more difficult than I'd wanted), but I got there nonetheless. He was satisfied!

There was a quick Q&A, but basically he said that there were no other issues found within my knee during the surgery, and that if I keep on track with PT he expects nothing less than a full recovery. I didn't think he'd tell me any differently, but it was great to hear! From here I won't need to see Dr. Shapiro for another month.

And, I hope this isn't too long-winded (feel free to stop reading) but when the Dr's assistant [Krista!] came to re-tape the incision area, I learned something new. After surgery my incision had been stitched up from the inside using bioabsorbable stitches. Up until today there had been just one piece of vertical tape, which had a white string coming off of it. I thought this was just a piece of the tape, but this was the end of the stitching! So once untaped, Krista gave this string a gentle pull and cut it as close to the skin as possible. It was an odd sensation, but maybe moreso because I then knew that it ran inside of my knee and was holding the incision together!! In this pic you can kind of see the loose 'string' coming off the bottom of the one piece of tape that doesn't align w/ the rest:

I was then re-taped, and sent on my way. Before going, I asked if I could get a copy of the arthroscopic images taken during the surgery. They're in black and white, plus I have no clue what I'm looking at, but it's so great to have more fun images to share!

8 Days down... The better part of 6 months to go!

A Monumental Week [7 Days Post-Op]

Tomorrow is my 4th Physical Therapy and my first post-op appointment with Dr. Jeff Shapiro- I promise to get an entry up about that tomorrow... But, first things first: Here we are, 7 days post-op!!

If you would have told me this week would go by so quickly, I wouldn't have believed you. But trials and tribulations aside, there have been some definite improvements that have me keeping a positive mind in my eventual recovery!

• I can bend beyond 90 degrees and straighten to zero degrees
• I can bear all of my body weight on my surgical leg (veeery carefully)
• I can walk (albeit slowly and quite hobble-ish) without aid of crutches or a brace
• I can get up and down stairs without assistance
• I can drive
• I can bathe (woo hoo!)

Of course, there are many milestones including:

• Going up and down stairs w/o having to take them one at a time
• Walking w/o a limp
• Regain balance (on both and) in my surgical leg
• Regaining entire range of motion
• Running
• Returning to sports (this is KEY for my sanity!!)
• Getting back to 'normal' !

I understand this will take 6-12 months, and I'm not planning on being a hero and getting out there too early. However, I hope I can continue with physical torture... I mean therapy (!) with vigor until I'm where I am capable of being, both physically and mentally! Of course I wouldn't be able to do it without a strong network of support, so again, thank you to everyone for all your help and kindness.

And because everyone likes photos (or, is it starting to gross you out?!)... some Day 7 post-op pics, for reference:
Increased yellowing and bruising, primarily on the inside of the knee and a little down the shin.
Bruising has also come about on the back of the knee:

I don't seem to have any trouble straightening to Zero degrees, and there has been no change in the incision area, as I have not removed the tape nor gotten it wet. Bending the knee continues to be a challenge, and I can get it to about 100 degrees but not without pain.

Until tomorrow...